MEDICARE: ALLIANCE ENT AND HEARING CENTER, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center
2	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1184805848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE ENT AND HEARING CENTER, SC

Provider Business Mailing Address
First Line	:	PO BOX 26071
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-0071
Country	:	US
Telephone Number	:	414-727-0910
Fax Number	:	414-727-0920

Provider Business Practice Location Address
First Line	:	2727 N MAYFAIR RD STE I
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4400
Country	:	US
Telephone Number	:	414-727-0910
Fax Number	:	414-727-0920

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY A RIEDER
Credential	:	M.D.
Telephone Number	:	414-727-0910

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	07/22/2024

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